Antihypertensive treatment and change in blood pressure are associated with the progression of white matter lesion volumes: The three-city (3C)-dijon magnetic resonance imaging study
Circulation. 2011-01-10; 123(3): 266-273
DOI: 10.1161/CIRCULATIONAHA.110.961052
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1. Circulation. 2011 Jan 25;123(3):266-73. doi: 10.1161/CIRCULATIONAHA.110.961052.
Epub 2011 Jan 10.
Antihypertensive treatment and change in blood pressure are associated with the
progression of white matter lesion volumes: the Three-City (3C)-Dijon Magnetic
Resonance Imaging Study.
Godin O(1), Tzourio C, Maillard P, Mazoyer B, Dufouil C.
Author information:
(1)INSERM Unit 708 Neuroepidemiology, Hôpital la Salpêtrière, 75651 Paris Cédex
13, France.
BACKGROUND: Blood pressure (BP) is recognized as a major risk factor for white
matter lesions (WMLs), but longitudinal data are scarce, and there is
insufficient evidence for the benefit of antihypertensive therapy on WML
progression. We studied the relationship between BP change and WML volume
progression over time in a sample of 1319 elderly individuals who had 2 cerebral
magnetic resonance imaging examinations 4 years apart. We also examined the
impact of antihypertensive treatment on WML progression.
METHODS AND RESULTS: Subjects were participants from the Three-City (3C)-Dijon
Magnetic Resonance Imaging Study, a prospective population-based cohort of
elderly ≥ 65 years of age. WML volumes and their progression were estimated with
the use of a fully automatic procedure. We performed ANCOVA models first to
assess the association between BP change and WML progression and second to
estimate the relation between antihypertensive treatment and WML load
progression. Baseline and change in BP were significant predictors of higher WML
progression over time after controlling for potential confounders. Among subjects
with high SBP (≥ 160 mm Hg) at baseline not treated by antihypertensive
medication, antihypertensive treatment started within 2 years was related to a
smaller increase in WML volume at a 4-year follow-up (0.24 cm³; SE=0.44 cm³) than
no hypertensive treatment (1.60 cm³; SE = 0.26 cm³; P = 0.0008) on multivariable
modeling.
CONCLUSIONS: Our findings reinforce the hypothesis that hypertension is a strong
predictor of WML and that adequate treatment may reduce the course of WML
progression. Because WMLs are linked to both dementia and stroke risks, these
results could have implications for future preventive trials.
DOI: 10.1161/CIRCULATIONAHA.110.961052
PMID: 21220733 [Indexed for MEDLINE]